Background: Periurethral cystic masses, including Skene's duct cyst and urethral diverticula, are rare and are often misdiagnosed for more common vulvovaginal cysts. Given their proximity to the urethra, correct diagnosis is needed for appropriate referral and surgical management to prevent complications, including fistula formation.
Case: A 36-year-old woman was diagnosed by her primary care physician with a Bartholin's gland cyst, which was confirmed on MRI. She was referred to a gynecologist for incision and drainage. However, on examination the cyst was noted to be more anterolateral on the vagina and more concerning for a Skene's duct cyst or a urethral diverticulum. She was referred to Urogynecology. The images were reviewed with the radiologist, who agreed that the lesion was more consistent with a Skene's duct cyst. She underwent successful excision of the cyst. The patient had an uncomplicated postoperative course and has normal bladder and urethral function.
Conclusion: Although imaging modalities are useful to assist in diagnosis of vulvovaginal lesions, clinical examination finding is also key in distinguishing periurethral cystic masses from their more common vulvovaginal counterparts.